Can a Spouse Be Paid to Be a Caregiver? Medicaid Rules by State (2026)

The State-by-State Table

State	Can a spouse be paid?	Who else can be paid	Program
Georgia	No The waiver excludes spouses, legal guardians, and representative payees.	A relative by blood or marriage who lives in the same home — often an adult child.	Structured Family Caregiving (Elderly & Disabled Waiver)
Michigan	No MDHHS bars spouses, whether hired individually or through an agency.	Most other family members and friends who are at least 18.	Home Help Program
Missouri	No State rule excludes the legal spouse and the legal guardian; everyone else may qualify.	Almost anyone else — adult children, siblings, relatives, friends — including live-in caregivers.	Consumer Directed Services (CDS)
New York	No State regulation bars payment to a spouse, parent, son, daughter, or child-in-law.	Other relatives — a sibling, grandchild, niece or nephew — and friends, employed as certified aides.	Medicaid Personal Care Services (licensed agency model)
Ohio	Conditionally One of the few states with a real spouse path — when no other caregiver is available and care needs are extraordinary.	Adult children, siblings, and other relatives — including those holding power of attorney or guardianship.	PASSPORT / Ohio Home Care Waiver (OAC 5160-44-32)
Pennsylvania	No The CHC waiver excludes the spouse, legal guardian, power of attorney, and representative payee.	An adult child, sibling, other relative, friend, or neighbor.	Community HealthChoices (CHC)
South Carolina	No The waiver excludes the spouse and any legally responsible guardian.	Qualified relatives — an adult child, sibling, or other family member.	Community Choices Waiver
Texas	No Under the Consumer Directed Services option, the spouse and the legally authorized representative cannot be hired.	An adult child, sibling, other relative, friend, or neighbor.	STAR+PLUS & Community First Choice (CDS option)

Covering the 8 states we currently serve; more states are added as our verification and partner coverage expand. Every row is sourced in the state sections below.

State Details & Official Sources

Georgia — Structured Family Caregiving (Elderly & Disabled Waiver)

Georgia's Structured Family Caregiving pays a live-in family caregiver a daily stipend through a Medicaid-approved agency. By waiver rule, the paid caregiver cannot be the participant's spouse, legal guardian, or representative payee, and a parent cannot be paid for a minor child.

The caregiver must be related to the participant by blood or marriage and share the home — an adult child, sibling, or grandchild are common fits. Friends and neighbors are not eligible under SFC.

See if you qualify in Georgia Source: Georgia's Elderly & Disabled 1915(c) waiver application (PDF)

Michigan — Home Help Program

Under Michigan's Home Help Program, the client chooses their own caregiver and is officially the employer — but by MDHHS rule the caregiver cannot be the client's spouse, and a parent cannot be paid to care for their minor child.

An adult child, sibling, other relative, friend, or neighbor who is at least 18 can serve after enrolling as a provider and passing a background check.

See if you qualify in Michigan Source: MDHHS — Home Help program (michigan.gov)

Missouri — Consumer Directed Services (CDS)

Missouri's rule is one of the simplest in the country: under Consumer Directed Services, the consumer can hire anyone except their legal spouse or legal guardian. The attendant may live in the same home.

Missouri's agency-model In-Home Services works differently — there, immediate family members cannot be the paid caregiver — which is why CDS is usually the path for families who want a relative providing the care.

See if you qualify in Missouri Source: Missouri DHSS — HCBS frequently asked questions

New York — Medicaid Personal Care Services (licensed agency model)

New York's personal care regulation (18 NYCRR 505.14) does not allow payment to the person's spouse, parent, son, daughter, son-in-law, or daughter-in-law.

Other relatives and friends can often serve: the chosen caregiver becomes a New York State-certified aide employed by a licensed home care agency, which provides the training and handles payroll. Rules apply to relatives living in the same home.

See if you qualify in New York Source: 18 NYCRR 505.14 — Personal care services regulation

Ohio — PASSPORT / Ohio Home Care Waiver (OAC 5160-44-32)

Ohio stands out: under Ohio Administrative Code 5160-44-32, a spouse can be paid — employed through an agency or through the participant-directed option — when no other willing and able caregiver is available and the care needs are extraordinary, generally up to 40 hours per week unless the program authorizes an exception.

Separately, a relative holding a legal designation (for example, an adult child with power of attorney or a court-authorized guardian) can provide covered services without those extra conditions. Under Structured Family Caregiving specifically, a spouse or legal guardian generally cannot be the paid caregiver.

See if you qualify in Ohio Source: Ohio Admin. Code 5160-44-32 — family/legal-representative caregivers

Pennsylvania — Community HealthChoices (CHC)

Pennsylvania's Community HealthChoices waiver lets the participant direct their own care — including through the Services My Way budget option — and family members can provide paid personal assistance.

By program rule, the participant's spouse cannot be the paid caregiver, and neither can their legal guardian, power of attorney, or representative payee. Other family members, friends, and neighbors can serve.

See if you qualify in Pennsylvania Source: Approved CHC 1915(c) waiver application (pa.gov, PDF)

South Carolina — Community Choices Waiver

South Carolina's Community Choices waiver pays qualified family members for covered services like attendant care, and its self-directed option lets the participant choose and direct their own worker.

By waiver rule, the participant's spouse cannot be the paid caregiver, and neither can a legally responsible guardian or a parent of a minor participant.

See if you qualify in South Carolina Source: Approved Community Choices 1915(c) waiver (scdhhs.gov, PDF)

Texas — STAR+PLUS & Community First Choice (CDS option)

Texas members can hire people they know as paid attendants through the Consumer Directed Services (CDS) option — an adult child, sibling, other relative, friend, or neighbor — with a financial management agency handling payroll.

By program rule, the member's spouse cannot be the paid attendant under the CDS option, and neither can the member's legally authorized representative.

See if you qualify in Texas Source: Texas HHS — How Consumer Directed Services (CDS) works

How this guide is verified

Every rule on this page was checked against the state's own materials — the approved 1915(c) Medicaid waiver application, the state administrative code, or the state Medicaid agency's official pages — in a review completed October 1, 2026. We do not cite commercial websites. Program rules change; before making decisions, confirm with the program or ask us and we'll help you check.

Questions

Questions Families Ask About Paying a Spouse or Family Caregiver

Does Medicaid pay a spouse to be a caregiver?

In most states, no — Medicaid home-care programs commonly exclude the spouse (and often the legal guardian) from being the paid caregiver. A few states, like Ohio, allow it in limited circumstances. The same programs usually DO allow other family members — an adult child, sibling, or other relative — to be paid, which is how most families use these programs.

My state says no to spouses. Can anyone else in my family be paid?

Usually, yes. In every state in this guide, at least some other family members can be the paid caregiver — most commonly an adult child. The rules on who qualifies, and whether the caregiver can live in the same home, vary by state and program; the table above links to each state’s details.

Does Medicare pay family caregivers?

No — Medicare does not pay family caregivers. These programs are Medicaid programs, so the person needing care must have (or qualify for) Medicaid in their state. Many people have both Medicare and Medicaid; those "dual eligible" individuals can be served.

How do I find out if my family qualifies?

Start with your state’s page from the table above — each explains the program, who qualifies, and how enrollment works, with a short eligibility form. We are a free enrollment matching service: we help you check your options and connect you with a licensed, Medicaid-approved agency in your area. Eligibility is always determined by the state program.

Can a Spouse Be Paid to Be a Caregiver? Medicaid Rules, State by State